The provision of an improved water supply service to the poor urban areas of Addis Ababa, Ethiopia is essential, given that large numbers of people living in the city have problems of access to a reliable and adequate potable water supply. Only 62% of residents receive an adequate water supply in the City. Clearly, much still needs to be done in this regard. Additionally, water resources need to be managed far more efficiently. This study examines water resource management in Ethiopia using the political ecology framework focusing on issues of equity with regard to access to safe and clean water in the poor areas of the city of Addis Ababa. The key objectives of this study are: to evaluate existing water resource management practices in Ethiopia; assess access to drinking water and; propose sustainable and social justice based management strategies to water resources in Addis Ababa. Qualitative and quantitative research techniques within a purposive sampling methodology are used in this study. The study covers water use and consumption patterns; availability and reliability of water; gender; income; monthly water expenditure and time taken to fetch water from existing sources. The results indicated that more than 37% of the sample households use less than 20 litres per person per day. Most households pay a relatively high price for drinking water with the average cost of ETB 12.87/m3, or 9.19/m3 Rands for water. The majority of households are willing to pay for a new improved water supply. However, the initial connection fee has to be in small instalments linked to their level of income. An innovative financing and cost recovery mechanism is required to increase the coverage of a reliable and safe water supply at an affordable price. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

Rape is a serious crime and is a huge problem in Ethiopia. It has a devastating effect on the victim and society as a whole. The Ethiopian news is peppered with reports of this crime. Anorganized and sophisticated way in which the perpetrators of rape can be identified is by the use of modus operandi information. The aim of this research is to evaluate how modus operandi can be used as a perpetrator identification technique in the investigation of rape cases in the Gulele policing area. For any investigation to be successful, the investigator must have the objectives of crime investigation in mind. In the investigation of crime, the collection of evidence is important and there are two basic important principles, namely Locard’s principle and the chain of custody that investigator must comply with. These will ensure that evidence is admissible during a trial. Evidence is found on a crime scene. In rape cases, the body of the perpetrator and the victim can be seen as the crime scene. For evidence to be applicable to the investigation, it must first be identified and then individualised. It is important for investigators to be familiar with the concept of modus operandi, and the influencing factors. The purpose of this research is to provide practical recommendations on the best practices for the use of modus operandi. / Police Practice / M. Tech. (Forensic Investigation)

This study aimed to investigate factors affecting the participation of women-owned MSEs in the manufacturing sector in two selected sub-cities of Addis Ababa, namely, Kolfe Keranio and Nefas Silk Lafto sub-cities and to explore and gain a deeper understanding of the lived experiences and participation of women who own MSEs in the manufacturing sector as well as government entities that support these MSEs. The study adopted a qualitative, exploratory research approach. Semi-structured in-depth interviews were conducted to collect data from women who participated in the manufacturing sector, government officials, MSEs experts in the sub-cities and gender office professionals who worked closely with women’s MSEs in the manufacturing sector. Besides, direct observation was used to get firsthand information concerning the nature of women-owned MSEs and their working environments such as limited working space, lack of warehouses, and physical constraints relating to the use of stairs in storeyed buildings, among others. Document review and secondary data were used to triangulate the results from the interviews and obtain quantifiable data that could be used to clarify certain issues in the study. The data were analyzed using thematic data analysis to identify how the theme related to the research objectives. The researcher used a table to visualize the coded themes to determine which was the major problem, support, and characteristics of women-owned MSEs. The study revealed that women have limited education levels and skills. It is thus difficult for women who own MSEs to exploit advantages or opportunities to expand their business. The findings also reported the inability to access finance for MSEs start-ups and expansion. Women generally lacked information regarding various aspects of MSEs during the establishment of their businesses. Women-owned MSEs have received some support, particularly from government agencies. However, the support they are currently receiving is inadequate to enable them to transform their business. Women-owned MSEs still face problems on many fronts including workspace, limited finance, outdated technology, poor marketing strategies were among others that need addressing. To develop women-owned MSEs and empower other women in the field, the government, the public sector, and formal financial institutes should be informed on the value of gender-balanced contribution in the informal sector enterprises. It is recommended that there should be a greater focus on the social and economic empowerment of women, as they constitute a vulnerable social category that is critical in development endeavors. / Development Studies / M.A. (Development Studies)

Background: The health benefits and economic gains of exclusive breastfeeding for the mothers and the new-born are well-documented in the literature as discussed in the background and the rationale for this study. The effectiveness of the social cognitive based interventions in promoting breastfeeding among women in general is also documented. However, there is lack of evidence regarding social-cognitive strategies that could be used to promote exclusive breastfeeding practices among primiparous mothers in Ethiopia means that current exclusive breastfeeding promotion interventions or strategies may not produce the expected outcomes. This assumption seems to be supported by low rate of early initiation of breastfeeding in country (52.1% instead of at least 75% as recommended by WHO) and shorter period of breastfeeding (one month) among mothers in Addis Ababa (CSA and ICF 2012) despite various strategies and interventions that have been implemented. Aims: The study was conducted with the aim of determining the social-cognitive predictors of exclusive breastfeeding among primiparous mothers during the first six months post-delivery with the view of developing social-cognitive strategies to promote exclusive breastfeeding practices among primiparous mothers in Addis Ababa, Ethiopia. Research design and method: The study was carried out within the quantitative positivist paradigm. The study was divided into two phases. The researcher used quantitative longitudinal, descriptive, exploratory and correlational designs to determine the social cognitive predictors of exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia within the first six months post-delivery. The results of the first phase assisted the researcher to design social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers using a Delphi survey. A Delphi survey design was used to assist the researcher to develop the social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers. It consisted of three rounds of mailed self-completion questionnaires. The Delphi was supported with critical review and synthesis of literature throughout the strategies’ development process. Descriptive summary statistics were used to analyse the prenatal breastfeeding behaviour of 141 primiparous mothers followed from the last antenatal care visits up to six months after delivery. Bivariate correlational and multiple logistic regression analyses were used to identify the social cognitive determinants and predictors of exclusive breastfeeding within the first hour post-delivery and six months thereafter. Findings: Positive breastfeeding outcome expectancy and high breastfeeding self-efficacy were identified as the independent social cognitive predictors of exclusive breastfeeding among primiparous mothers in Ethiopia. These predictors were used to develop social cognitive strategies to promote exclusive breastfeeding, which comprise six main components: (1) scientific evidence for the strategies, (2) the rationale for the strategies, (3) the aim of the strategies, (4) the scope of the strategies, (5) the guiding principles, and (6) the key results areas. These strategies were developed and validated with the inputs from 37 experts on breastfeeding and social cognitive theory. Two key results areas (build individual capacity for exclusive breastfeeding and create an enabling environment) and five strategic objectives were formulated and validated. Conclusions: The successful implementation of the social cognitive strategies to promote exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia as described above will require among others (1) in-service training on social cognitive skills for healthcare providers with focus on how to build self-efficacy and outcome expectancy, (2) the development of self-efficacy and outcome expectance assessments tools relevant to the Ethiopian context, and (3) additional support and resources from the healthcare managers. Recommendations: To the researcher recommend that programs aimed at promoting exclusive breastfeeding practices among primiparous mothers should be based on the combined attributes of positive social cognitive outcome expectance and high breastfeeding self-efficacy. Further research is needed to develop assessment tools for breastfeeding self-efficacy and outcome expectancy before the implementation of the proposed strategies. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respectively, following which two Delphi rounds with experts resulted in agreement on a contextually accepted integrated framework. The findings revealed that promotive and preventive services for chronic diseases were not optimally integrated in the routine health care services of the health facilities. Most health facilities lacked skilled health professionals, adequate medication and equipment to provide a comprehensive integrated service. The study emphasized the need for health service providers to undergo a paradigm shift and additional training in order to provide a comprehensive, patient-centred, integrated health service instead of only treating patients’ complaints. To assist this approach, the study affirmed the Integrated Health Service (IHS) framework as a tool which comprehensively demonstrates the cause, effect and progression of chronic diseases and the appropriate interventions which health professionals can apply in managing diseases or their risk factors. Recommendations for effective, integrated promotive and preventive health care, included the development of guidelines, protocols and policy documents for cultivating a healthy lifestyle, adopting effective disease prevention approaches, re-designing medical school curriculums, and staffing health facilities with trained and specialized staff, capacitating health facilities with the necessary equipment, medication and supplies that would enable the provision of an integrated health care service. / Health Studies / D. Litt. et Phil. (Health Studies)

Introduction: HIV referral and linkage system in many countries in general and in Ethiopia in particular was poorly characterised by low linkage rate. The purpose of this study was to analyses factors associated with poor referral and linkage system and develop strategies to improve the system. Methods: A sequential mixed method approach using exploratory descriptive study design was employed. The study was conducted in Addis Ababa, Ethiopia and it was conducted in two phases. Phase I involved data collection and analysis as evidence for the development of strategies while phase II was the development of strategies. For phase I, data were collected in steps 1 and 2 using individual interviews and focus group discussions respectively. The study participants were programme owners and partners who were supporting facilities during the data collection period in step 1 and health care providers in step 2. A total of 4 individual interviews and 3 FGDs were conducted with purposively selected participants. Data were analysed using computer assisted software called OpenCode version 4.2. Results: The findings revealed five themes namely, issues of referral and linkage practice, ensuring linkage through communication, issues of health care, issues of health care system and issues of partnerships and Health Bureau. Many gaps that affected the referral system were identified and in phase II, nine strategies were developed to strengthen the referral and linkage system. Conclusion:The results of this study highlighted weaknesses in the referral and linkage system of the HIV positive clients from counselling and testing services to chronic care and proposed strategies to strengthen those weaknesses. Measures to operationalise those strategies are also proposed. The successful implementation of the proposed strategies depends on the support of the ministry of health and regional bureau in terms of resources and the readiness of the health care providers to adhere to the proposed measures. Intervention research is needed to test the effectiveness of the proposed strategies. / Health Studies / D. Litt. et Phil. (Health Studies)

This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M. Public Health

Background - Khat is a mild stimulant plant chewed by a limited segment of the population mainly in the eastern parts of Ethiopia for social facilitation and religious purposes. In recent decades, the use of khat has spread to all parts of the country and its social, economic and political impact has increased significantly at national level. In cities like Addis Ababa, the traditional purposes are superseded and it is now chewed mainly for recreational purposes. Following this development, many people have raised concerns on the potentially adverse socioeconomic and psychological effects of khat on the current generation, particularly the youth. The main issues raised are the misuse of income, the waste of productive time on chewing khat, and the adverse consequences on family cohesion and health. Those who argue in favor of khat cite its positive impact on increasing productivity, high economic returns and traditional values. These arguments on khat are not based on substantiated evidence and this research attempted to answer this question by assessing the ‘positive’ and ‘negative’ socioeconomic and psychological effects of khat on the chewers living in Addis Ababa. Drug control policies intersect with much of the 2030 Agenda for Sustainable Development and Ethiopia has not yet developed a policy on khat. This research intends to make its contribution to the development of the policy by highlighting the socioeconomic and psychological effects on the chewers. Objective –To assess the effects of khat on the income; use of time/time management/; productivity, and psychological well-being of chewers in the city of Addis Ababa. The study is related to policies of Ethiopia in relation to the production, marketing and consumption of khat. It makes policy recommendations based on the assessed costs and benefits. Methodology - The study, using snowball sampling, was conducted in 2018 with 84 khat users. The data collection methods employed were structured questionnaire focus group discussions, narrations of life stories and interviews with key informants. An extensive literature review was also conducted. Result – Respondents reported the diversion of financial resources to purchase khat compromising other personal and family needs and a waste of working hours on chewing khat. There were mixed results found on its effects on productivity. Users also reported that khat made them vulnerable to other addictions such as alcohol, cigarettes and hard drugs and to a number of social and psychological problems. Conclusion - Khat has a significant adverse impact on income and the efficient use of time of chewers. The findings on the effect on productivity are inconclusive. The reported physical and psychological effects on productivity need to be scientifically proven. Chronic use of khat is detrimental to mental health and leads to other serious health consequences. It distorts social and family relationships and inhibits the ability of the chewer to significantly execute his/her social responsibilities. It hurts the self-esteem of the chewers and makes them lose a sense of purpose in their lives. Thus, there is an urgent need to develop a national policy on khat. However, a comprehensive study should be conducted to exploit the potential benefits of khat (mood lifting and medicinal values) by using khat in a modest and controlled way. The social and economic interest of the suppliers; its religious and cultural significance, and environmental impacts should also be considered. / Development Studies / M.A. (Development Studies)

This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M.A. (Public Health)

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)